Formal and Material Cooperation

Ethics & Medics, June, 1995
Reproduced with permission

Introduction
Controversy in the workplace involving Catholics often centres around
distinctions drawn between formal and material cooperation with evil. An
introduction to the Catholic perspective may assist in clarifying some
of the issues involved in particular cases. [Administrator]

The impressive realism and coherence of Christian
morality is based in part upon the fundamental
convictions that (1) there is an objective moral
order which can be known by the intellect and that
(2) some actions are ''intinsically evil,'' that is,
they are never morally justifiable regardless of the
circumstances of the act. This is one of the major
teachings of Veritatis Splendor. Three
theological principles have been developed to deal
with the ethical permissibility of actions which
relate to either physical evil or the moral evil of
other agents. These are known as (1) the principle
of the double effect (see Ethics & Medics
3/95), (2) the choice of the ''lesser evil,'' and
(3) the principles of cooperation. These concepts
have been taught and reflected upon, and, with the
exception of the second (lesser evil), they have
enjoyed generally unquestioned acceptance in
philosophical ethics and Catholic moral theology.

Historical Origins

St. Alphonsus Liguori (d. 1787) made the
principles of cooperation acceptable by introducing
the distinction between formal and material
cooperation and by a consideration of scandal as a
serious invitation to sin. Cooperation in the
ethically significant sense is defined as the
participation of one agent in the activity of
another agent to produce a particular effect or
share in a joint activity. This becomes ethically
problematical when the action of the primary agent
is morally wrong.

There are three basic examples of cooperation on
the part of individuals: the hostage, the taxpayer
and the accomplice. The participation or cooperation
of these individuals in the morally questionable
acts of the principal agent is quite distinct one
from another. The hostage is forced with threats to
comply with the evil act of another person. Fear
more or less compels the hostage to cooperate. This
diminishes his culpability and in some cases
eliminates it completely. In contrast, the
accomplice may perform the same act as the hostage,
but culpability is imputed fully because cooperation
in this instance is free and willed (directly
intended). The taxpayer is an example of one who
cooperates with a principal agent (the government)
in an important - in fact, essential - mission
(societal governance). Nevertheless, it is possible
that the government may sponsor activities which are
immoral. The taxpayer then contributes in some
degree to this immoral activity. However,
contributing to the stability of society is not an
intrinsic evil but a good.

The Principal Distinctions

Among the principles of cooperation, the primary
distinction is between formal and material
cooperation. Formal cooperation is a willing
participation on the part of the cooperative agent
in the sinful act of the principal agent. This
formal cooperation can either be explicit (''Yes,
I'm happy to drive the getaway car because I want to
be an accomplice'') or implicit.

''Implicit formal cooperation is attributed when,
even though the cooperator denies intending the
wrongdoer's object, no other explanation can
distinguish the cooperator's object from the
wrongdoer's object'' (Ethical and Religious
Directives for Catholic Health Services, [1994]
Appendix). the motto of the implicit formal
cooperator is ''I am personally opposed, but...''
This cooperation is as immoral as explicit formal
cooperation.Material cooperation has several
inherent distinctions, the most basic being that of
immediate and mediate material cooperation.
Theologians maintain that in the objective order,
immediate material cooperation is equivalent to
implicit formal cooperation because the object of
the moral act of the cooperator is indistinguishable
from that of the principal agent. Those who use the
term ''immediate material cooperation'' have
understood this as ethically unacceptable behavior.
An example of this would be any form of employment
in an abortion clinic.

Immediate material cooperation is contrasted with
mediate cooperation. Here the moral object of the
cooperator's act is not that of the wrongdoer's. (An
example of this would be a health care worker
employed in a secular hospital that also provides
for morally prohibited procedures, but does not
require the conscientious objector to such
procedures to participate.) This kind of cooperation
can be justified (1) for a sufficient reason and (2)
if scandal can be avoided. It is a form of
cooperating with the circumstances surrounding the
wrongdoer's act. Depending on how closely these
circumstances impinge upon the act, there is a
distinction between proximate and remote material
cooperation. (Proximate material cooperation would
be the recovery room nurse who cares for all
post-surgical patients, including those who may have
undergone morally illicit procedures. This form of
routine care is not intrinsically evil.)

Further, necessary material cooperation is that
without which the sinful act could not occur.
Contingent cooperation (also called free
cooperation) is that without which the evil act
would still take place. An example of necessary
material cooperation would be being the only
anesthesiologist available to assist with a woman
undergoing a combination C-section and tubal
ligation. Contingent material cooperation would
exist if one were not the only such professional
available.

Application to Modern Corporate Partnerships

The theological development of the principles of
cooperation has considered the actions individuals
who cooperate with the evil actions of others.
Contemporary theological considerations are not so
restricted. There are questions about ''corporate
actions'' of cooperation, such as joint ventures
between health care institutions which may be
morally questionable because some actions of one of
the partner institutions may be ethically
unacceptable to the other cooperative institution.
Very few acts of the non-Catholic partner may be
morally wrong, and the rest quite good. Apart from
the morally illicit procedures, their provision of
health care is not intrinsically evil. That is why
the analogy of the taxpayer to describe this
cooperation is so apt.

A complicating factor here is the fact that
''cooperation'' between institutions or systems is
an arrangement made on the level of a legal
corporation. The cooperative venture has a very
precise and clearly defined identity and purpose,
which may not be evident in the public forum. The
partnership is a legal and/or corporate structuring
intended to perform only functions (1) which are
mutually agreeable to all partners, (2) which do not
include any procedures which any partner disagrees
with on moral grounds, and (3) which explicitly
separate the partnership from activities which an
individual partner may continue to engage in. Why is
this sort of partnering necessary? There are several
reasons. First, clinical medicine has reduced the
need for the present number of hospital beds. Many
procedures are handled on an out-patient basis, more
complicated procedures require a shorter hospital
recovery period, and, in the health care market,
competition is cost-driving, not cost containing,
force. The need to down-size acute care settings and
to create state of the art diagnostic and day
treatment centers has led to the realization that
health care must be cast in another form which is
often referred to as ''rationalizing'' care.

The practical conclusion to the re-configuration
is that a ''stand alone'' position is not always a
viable option. In most cases it is foreseen that
isolation would entail eventual closure. Market
pressure is considered the ''sufficient reason''
which is one of the ''ingredients'' necessary to
justify material cooperation. Scandal must also be
overcome. Scandal is not the same as a public
relations problem. Scandal is the serious suggestion
that evil is attractive or permissible. Any
partnering between Catholic and non-Catholic health
services must avoid the impression that Catholic
moral doctrine is not being observed.

Five Basic Principles

There are five basic principles the Pope John
Center is using to evaluate partnerships.

(1) Cooperation must be
mediate material, never formal or immediate
material.

(2) We can only do together
what all partners agree to be appropriate. This
means that while the partnership need not be
Catholic, it must nevertheless observe the Ethical and Religious Directives as respecting
the ''corporate conscience'' of the Catholic
partner.

(4) Any morally illicit
procedure(s) provided on the campuses of
non-Catholic alliance partners must be excluded from
the new alliance corporation through separate
incorporation (governance, administration and
finance).

(5) All publicity should be
straightforward, i.e., the need to form an alliance
for the survival of a worthy apostolate should be
made known, the good achieved by rationalizing
health care must be to the patients' benefit,
immoral procedures must be excluded from the
partnership (while these services may still be
available on the campuses of some partner[s]), and
this publicity should also appear in the promotional
literature of the Catholic hospital. The observance
of these principles should issue in a morally sound
and scandal-free partnership that will contribute to
the Catholic health care tradition.